About six months after L.A. County revamped the way it provides health care to poor immigrants living in the U.S. illegally, there are signs that the program may be improving their quality of care.
But among clinics providing this care, there are also concerns that the new model may turn out to be a bad deal financially unless the county changes its rules for how clinics can sign people up for the program, My Health L.A.
The county has been subsidizing health care for unauthorized immigrants for decades. Under the old system, the county reimbursed clinics $94 each time they treated an immigrant. But patients often bounced between clinics, which made it difficult for clinics to coordinate their care. Tests and treatments were often duplicated, which wasted county money.
Under My Health L.A., patients have to choose one clinic and go there for all of their care. The idea is that if a single clinic is coordinating a patient’s care, that patient is more likely to stay healthy.
To give clinics a financial incentive to keep their patients healthy, the county has changed its reimbursement formula. Now, instead of being paid $94 each time it sees a patient, a clinic receives a smaller amount, $32 a month, for every person who signs up to get care, regardless of how often the clinic treats that patient.
The idea is that if a clinic finds ways to keep a patient healthy, it can use more of the money it receives for that patient to treat sicker patients.
"It’s a way of looking at cost containment through improving the quality of care that you provide," says Nina Vaccaro, who runs the Southside Coalition of Community Health Centers. "The healthier your patients are, that’s a win-win for everybody."
Clinics are already looking for ways to put this theory into practice. The South Central Family Health Center is planning to put more effort into educating its patients about how to manage their chronic conditions.
Clinica Monseñor Oscar Romero, near downtown L.A., has started giving diabetic patients a type of insulin that’s easier to take than the one it was previously providing, even though the new insulin is much more expensive.
"That extra expense is worthwhile now under the new program because it will keep patients’ diabetes better controlled," which will save Clinica Romero money in the long run, says the clinic’s Dr. Maria Ayala.
The benefits of the more expensive insulin are already evident for some of her patients, notes Ayala.
"It’s really wonderful to see," she says. "Their sugars are getting better. Their eyes are getting better, their kidney function is getting better."
On a recent afternoon, one of those patients, Maria Menchaca, says she is hopeful the change will help her, too. She’s struggled with diabetes for years despite having access to insulin, because the old insulin the clinic provided required that she eat throughout the day. Menchaca says she rarely had time to eat while she worked cleaning houses and recycling cans, so she kept getting sicker. The new insulin doesn’t require her to eat as often.
"I’m hoping this change will make me better," she says.
Clinica Romero has signed up more than 3,000 patients for My Health L.A., according to CEO Sandra Rossato. To meet demand, it’s expanded hours and is hiring more doctors so it can provide a first appointment to each patient within three months, as the county requires.
But while Clinica Romero and other clinics report mostly positive changes, some health care facilities are worried that the program will end up hurting them financially.
Genevieve Filmardirossian, CEO of the South Central Family Health Center, says one big problem is that clinics are only allowed to sign people up for the program at the clinic itself.
Many immigrants living in the country illegally are fearful, and won’t step into a clinic unless they’re sick, asserts Nina Vaccaro, who runs the South Side Coalition of Community Clinics. And those healthy patients are the ones that clinics need to make My Health L.A. work for them financially.
Filmardirossian says this wouldn’t be a problem if clinics could sign people up at health fairs, churches or in neighborhoods.
"If that doesn’t change, it could bankrupt us," she maintains.
Amy Viste, the county official in charge of My Health L.A., says she is open to that kind of change, and is in discussions with clinics about a number of ways to make enrollment easier.
"But overall, I think the clinics are doing well, they’re enrolling high numbers of patients," Viste adds.
As of late April, more than 100,000 people had signed up for My Health L.A. The county has only budgeted enough to enroll about 150,000, even though there are an estimated 400,000 to 700,000 uninsured unauthorized immigrants in L.A. County.
Viste says the new program has made it easier to collect data on the kind of care patients are receiving and whether they’re getting healthier. If the program shows it can improve patients’ health while saving money, the county could consider expanding it at some point, she adds.